Many of the perceptions we have about vaccines, and the people who refuse them, are wrong.
This is something that's become increasingly clear as I've spent the past month reporting on the current measles outbreak — and the people who refuse vaccination.
When I took a closer look at the biggest cluster of US measles cases in about 20 years — in 2014 — I found that "patient zero" wasn't a granola-crunching hippy or Jenny McCarthy acolyte. It was an Amish man in Ohio. He spread the disease to more than 300 unvaccinated people in his community, accounting for more than half of the 2014 measles cases in the US. The Amish vaccine-refusers didn't get as much press as the granola crunchers or private-school moms, but they caused even more damage to public health.
In another piece on "vaccine delayers," I documented a little known group of parents who aren't quite anti-vaxxers but they also don't always vaccinate their children according to national guidelines. Instead, they invent their very own immunization schedules that involve delaying some vaccines and skipping others. (These alternative schedules, it should be noted, are not based not on science but a much-debunked kids' book that's known as the "bane of pediatricians' existence.")
Here are other important vaccine myths you need to know about.
1) There's a massive uptick in anti-vaxxers in the US
A recent New Yorker article stated, "Increasingly, a dangerously high percentage of parents are choosing not to vaccinate against a disease that has killed more children than any other in history." This narrative has been bandied about in all corners of the media lately. And according to the data, it's not true.
In reality, the increases and percentages of people opting out are rather modest.
Federal data show there has been no drop off in vaccination rates over the past decade. In fact, only about two percent of the population refuses vaccines outright. All 50 states have had school immunization requirements since the early 1980s, though some now allow medical and philosophical exemptions.
Dr. Doug Opel, a Seattle pediatrician who studies vaccines, said the best evidence for an increase in the number of parents refusing or delaying vaccines comes from studies, such as this one, by the researcher Saad Omer. Omer finds that, between 1991 and 2004, the state-level rate of non-medical exemptions increased from less than one percent to about 1.5 percent.
The states that allowed religious exemptions had a steady opt-out rate of about one percent during the period. In States that were more lax — allowing philosophical or personal beliefs exemptions — the mean exemption rate increased from 0.99 to 2.54 percent. So his work suggests that if you allow more people to opt out of vaccines for various reasons, they may — but these refusers still represent a tiny minority.
Opel noted that there is other national survey data that have followed parent attitudes about vaccines, and they show consistently high numbers (as many as 30 percent) who have some doubts. "While this is a larger number, we don’t have a consistent data set or routine sample from which to get these numbers, so it's hard to say how it has been trending over time." What's more, these surveys measure attitudes, not behavior. And just because someone has concerns, doesn't mean they'll act on them.
This isn't to minimize the fact that opting out for non-medical reasons is problematic; if everyone who could get shots in the US took them, we wouldn't be in the middle of measles and mumps outbreaks. And we do know that, hidden in the statistics about state and national averages, are geographic clusters of unvaccinated people. But it's just to say that the data we have now don't suggest a growing army of denialists.
2) There's a religious basis for vaccine refusal
Reporting on the Amish piece, I learned that in this particular Ohio community, people weren't abstaining from vaccines because of their religion. Though it was religion that united the group, they were actually acting on a collective fear about side effects from the MMR jab, after rumors about the vaccine spread through the community. What's more, there is no anti-vaccine doctrine in this religion.
Slate did a good job of outlining the questionable basis of supposed religious exemptions. "The only two religions that have any possible negative stance (though it’s not even clear that they do) on vaccination are Christian Scientists and the Dutch Reformed Church," the author writes. Christian Scientists' views seem to have to do with beliefs about modern medicine, and the Dutch Reformers share fears about side effects, and also a belief that "vaccines interfere with the relationship with God."
3) Most unvaccinated people are wealthy and educated
We tend to forget this in the coverage of Marin County's reported dislike of vaccines, but we have good data to suggest that it's often the poorest among us who miss their routine jabs.
The CDC, for example, has found that family income is a "significant predictor" of whether or not a child will get all the vaccines they need." Counties across the US with lower vaccination rates are often poorer, one CDC report says. "In particular, lower county-level vaccination coverage rates were found to be associated with higher levels of housing stress."
A new survey of Americans, conducted by a polling firm PorterNovelli, finds the same. And another article, about the latest National Immunization Survey findings, notes that — while the majority of American babies are getting vaccinated, "children living below the federal poverty level had lower vaccination rates than children at or above the poverty level for most vaccinations."